My health insurance has a $1,500 deductible. I will go through that this year. I have the opportunity to spend $245 out of pocket and have an additional $250 covered by a third-party payer, which will amount to about $500 toward my deductible. Assuming that this expense isn’t really necessary for me, should I nonetheless do this to help accelerate my deductible spending?
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No. If the expense isn’t necessary for you then don’t pay for it in the first place.
I’d say the play would be to stack any discretionary procedures you’ve been putting off into the current year, if you have any.
If I understand correctly, he’s saying he will have to pay his full $1,500 deductible without this additional $495 procedure. He’s asking whether it would make sense to undergo this extra procedure that a third party will pay $250 toward his deductible for (pushing total medical expenses to >$1,995), so his out of pocket for the year would only be $1,250.
Assuming the procedure doesn’t carry any risk, it seems at first glance to make sense to do that, assuming there are no legal barriers to doing so and the coverage after the deductible is >50%. However, I’m not familiar enough with insurance to point out any pitfalls.
Yes, this is what I’m getting at. Assume that total expenses for the year will be significant, and coverage after the deductible is 90%. It seems to make sense to me to accelerate that deductible spending, but I’m having a hard time working it out in my head.
IF you are 100% sure you’ll exceed your deductible and IF the 3rd party pays $250 to match your $250 and IF the $250 paid by the 3rd party goes to insurance and applies to the deductible then you would come out ahead financially doing it.
For example if know you’ll have $5000 in expenses (ignoring copay / coinsurance for simplicity):
If you don’t do the optional procedure in question then you pay $1500 deductible out of pocket.
If you do do the optional procedure then you’d pay $250 for the procedure, the 3rd party would pay $250 and then you’d pay $1000 more to hit the $1500 total deductible. Your net is $1250 thus saving you that $250 paid by the 3rd party.
Key question is to ensure the $250 paid by the 3rd party actually applies to your deductible.
I’d also ensure theres no risks in the procedure and that doing it is worth $250 of your time/ inconvenience and that the procedure doesn’t incur any other unexpected cost.
Agree that this is basically an opportunity to potentially save $250 on the deductible you were gonna pay anyway for other medical work. Worst case scenario, the payment by the third party does not count towards OP’s annual deductible and OP is back to square one.
I think the worst case scenario is he ends up with an infection from an unnecessary procedure and dies in the hospital.
But then he wins his bet against his life insurance company and maybe his family can even find grounds to sue the hospital for malpractice. Financially not bad for OP’s family, albeit possibly less optimal for OP…
I feel like I’m paranoid to site the possibility of a procedure ending in death but medical errors do kill lots of people.
Appreciate the comments on the ancilary possibility of physical risk but for purposes of this, assume zero adverse physical risk.
Call me cyncial but even stepping into a hospital or Dr office doesn’t have zero adverse risk.
But point taken.
If theres no physical risk then the other major concern is that the $250 paid by the 3rd party won’t actually count to your deductible. To be safe I’d get a confirmation in writing from the insurer that it counts on the deductible. If it doesn’t count then you’ve wasted your own $250 and time for nothing.
If the 3rd party gives you the money and you pay the total combined $500 then I really can’t see how it wouldn’t count. But the detail of how its being paid to who isn’t stated.
But assuming that it will count and all, does it make sense financially?
Yes. If it counts you should come out ahead $250 in the deal.